AUSTRAL UNIVERSITY OF CHILE
FACULTY OF MEDICINE
SCHOOL OF NURSING
"Perceptions of Users Treated with Biomagnetism as a Therapy for the Relief of Chronic Pain in the City of Valdivia"
Thesis submitted in partial fulfilment of the requirements for the degree of Bachelor of Nursing.
Carolina Cárdenas – Yocelyn Collinao – María José Mera
Valdivia, Chile
2013

TABLE OF CONTENTS
Abstract (Spanish) ............................................................................. 1
Abstract (English) .............................................................................. 2
Introduction ......................................................................................... 3
Theoretical Framework ...................................................................... 5
Objectives ......................................................................................... 12
Methodology ..................................................................................... 13
Future Directions .............................................................................. 16
Results Analysis ............................................................................... 17
Conclusion ....................................................................................... 27
References ....................................................................................... 31

1. ABSTRACT
The objective of this research was to determine the perception of Biomagnetism users regarding Biomagnetism as an alternative/complementary medicine for the treatment of chronic pain, making reference to the motivations they had for choosing an alternative therapy and describing the results perceived following the experience it provided.
The method used to carry out the study was phenomenological in nature, which focuses on the participants' subjective individual experience and seeks to recognise people's perceptions and the meaning of a phenomenon or experience.
The sample consisted of eight informants, users attending private centres where Biomagnetism is practised in the city of Valdivia, all of them over 18 years of age, with no exclusion based on sex.
Data analysis was carried out through data coding using an emergent matrix in the ATLAS.ti software. The purpose of this was to obtain three main themes: the motivations, the results perceived by the user, and the users' experience with Biomagnetism.
This study presents the user's experience of accessing a treatment different from that habitually used by the majority of the population. Those who receive it have reported multiple benefits in relation to their quality of life, proving effective in the treatment of chronic pain and/or as an adjunct to allopathic medicine, in addition to becoming an alternative field for the practice of the nursing professional in recent decades.

2. INTRODUCTION
In recent decades, healthcare has become more complex and specialised. The institutions that comprise it are made up of specialist physicians, social workers, psychologists, therapists, nutritionists, nurses, among others. However, there is an even larger group of healthcare providers outside hospitals who use alternative therapies, complementary to traditional ones, which would help to cure or heal illness and/or problems of various kinds.
The concept of healthcare has eliminated from the explanation of the health-disease process every magical or supernatural element in favour of a theory confined to the sphere of man and nature through observational facts interpreted rationally. Centuries have passed since this systematisation of the art of healing; however, conventional and traditional medicine continue to be used today (Bravo, 2009).
In general, studies on the use of Complementary and Alternative Medicine (CAM) are scarce. The lack of acceptance and knowledge regarding the use of CAM among healthcare professionals who provide conventional treatment is emphasised, as well as the lack of knowledge concerning the possible synergy between both therapies.
In recent years, a growing tendency towards the use of alternative or complementary therapy has been observed. There are various forms of therapy, among which Biomagnetism has stood out in recent decades; a therapeutic system developed by Dr Isaac Goiz Durán in 1988, in which powerful magnets are used to identify altered energy points within the organism. This therapy is responsible for restoring the order of certain points, thereby eliminating the cause of the disease.
In Chile, this type of therapy is somewhat unknown to the general population, since few studies have been carried out and published for the knowledge of users. However, in recent years an increase in the development of complementary medicine by healthcare professionals has become evident, owing to the courses currently offered by different universities throughout the country.
The preparation of this document is intended to preserve the research by recording it in a format that makes its retrieval possible at any time and facilitates its dissemination and communication to the different interested audiences.
The research was carried out with Biomagnetism users attending private healthcare centres offering this type of therapy in the city of Valdivia. The fieldwork covered the period from May to July 2013. The methodological design of the study corresponds to qualitative research under the phenomenological approach. The sampling design was carried out using the "Snowball" technique. Approximately ten participants were included, all of whom used this therapy for the treatment of chronic pain regardless of its origin.
Among the ethical considerations, written informed consent was obtained, and emphasis was placed on the interviewee's freedom to discontinue the interview. In addition, the confidential handling of information and respect for the participants were ensured.
The principal motivations arise from our responsibility as future healthcare professionals, with a comprehensive and holistic education, which encourages us to present and disseminate this type of therapy in order to promote greater knowledge among the general population.
3. THEORETICAL FRAMEWORK
3.1 HISTORY OF HEALTH AND DISEASE
The World Health Organization defines health as: "a state of complete physical, mental and social well-being," and adds: "and not merely the absence of disease or infirmity."
Health has been considered an essential state of human beings; it forms part of the fundamental right of every human being, who must preserve it and make it a fundamental part of his or her lifestyle. Watson, when referring to health, speaks of the unity and harmony between the mind, the body and the soul, relating it to the degree of coherence between what one perceives and experiences (Sanhueza, 2001).
Human beings exist within an organised society that continuously transforms the environment; therefore, the concept of health encompasses the individual's personal, social and ecological aspects. Within this constant change, a balance is sought between human beings and their environment, around which the health-disease process revolves. Thus, from its beginnings, ancient medicine was concerned with healing both body and soul, a fundamental characteristic that has remained in many cultures to the present day. However, these characteristics were progressively lost in Western medicine, which is characterised by a biomedical model, referred to by Méndez (1990) as the Hegemonic Medical Model (HMM).
Throughout the evolution of humanity, the concept of the health-disease process has had various meanings.
Around 475–435 BC, Empedocles of Agrigentum developed the theory that all natural beings are composed of a mixture of four elements: water, air, earth and fire. Therefore, when an imbalance exists among these components, disease occurs (Battistella). Since its beginnings, humanity has struggled against this, and above all against pain.
3.2 PAIN AND ITS TREATMENT THROUGHOUT HISTORY
"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective. Each individual learns the application of the word through experiences related to injury during early life. Undoubtedly, it is a sensation in one or more parts of the body, but it is also always unpleasant and, therefore, constitutes an emotional experience." (IASP, Seattle, Washington) (GES, 2005).
Prehistoric man believed that pain was located within the body and was caused by demons or evil spirits entering the soul through bodily orifices.
Later, during the time of the Sumerians (4000 BC), they used hulgil, the plant of joy. This was the first indication of the use of opium as an analgesic for the relief of pain. This affliction has been present since the origin of mankind, as reflected in the biblical phrase: "you shall give birth in pain" (Pérez, Abejón, Pérez JR., 2005).
By the eighteenth century, with the advancement of the medical sciences, treatment progressed towards analgesic-anaesthetic methods, marking a scientific era. Subsequently, as a result of the First World War (1914–1918), studies focusing on analgesia for the treatment of pain began. An example of this can be seen in Beecher's reflections on experiments conducted during that period concerning the placebo response, the psychological effect produced by the patient's conscious belief that they are receiving a medication, despite it having no pharmacological properties, of which the individual is unaware. As a result of these investigations, the scientific community concluded that both physical and psychological factors influence pain (Pérez, Abejón, Pérez JR., 2005).
In recent times, the treatment of pain has expanded through the use of opioid drugs, paving the way for the administration of morphine by the spinal route, in addition to multiple alternative techniques that the population has adopted as complementary therapies to allopathic medicine. Pain has been the most frequent cause of disability and one of the reasons that most repeatedly leads individuals to seek medical care (Van-der Hofstadt & Quiles, 2001).
3.3 CHRONIC PAIN
Episodes of chronic pain, unlike acute pain, which may be brief, lasting only a few moments or hours, consist of a condition that has become a stable part of a person's daily life. The sensory characteristics of this type of pain are sometimes non-specific and multifocal, and it may even persist in the absence of injury. It is defined as an exhausting experience, often associated with psychological suffering accompanied by symptoms of anxiety and depression, which would increase the perception of pain (Franco & Saone de Lucas, 2001).
According to allopathic medicine, the treatment of chronic pain is based on the WHO analgesic ladder: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, adjuvant medication (antidepressants, anticonvulsants, etc.), and psychological support, owing to the multiple factors that increase the sensation of pain, such as stressful thoughts and emotions.
3.4 COMPLEMENTARY MEDICINE
The World Health Organization (WHO) defines the terms "complementary medicine" and "alternative medicine", which in some countries are used interchangeably with "traditional medicine," as a broad set of healthcare practices that do not form part of the country's own tradition and are not integrated into the dominant healthcare system.
3.5 CLASSIFICATION OF COMPLEMENTARY MEDICINE
The National Center for Complementary and Alternative Medicine (NCCAM), an agency of the United States National Institutes of Health (NIH), defines complementary medicine as the diverse range of medical and healthcare systems, practices, and products that are not currently considered part of conventional medicine, and classifies complementary and alternative medicine therapies into five categories:
Alternative medical systems.
Mind-body interventions.
Biological therapies.
Manipulative and body-based methods.
Energy therapies.
The latter category, "Energy Therapies," belongs to the group of therapies that use energy fields to influence health and comprises two types.
Biofield therapies affect the energy fields that surround and penetrate the body. An example is Qigong, a component of traditional Chinese medicine that combines movement, meditation, and the regulation of breathing in order to improve blood circulation and optimise the body's immunity.
The second type corresponds to bioelectromagnetic therapies, which involve the unconventional use of electromagnetic fields (NCCAM, 2009). Biomagnetism is included within this latter category, a therapeutic system developed by Dr Isaac Goiz Durán in 1988, in which powerful magnets are used to combat parasites, bacteria, fungi, viruses, and other microorganisms that are the cause of various diseases.
A study published by the World Health Organization in 2002 highlights an increase in the use of Complementary and Alternative Medicine (CAM), reporting figures reaching 70% of users in Canada, 49% in France, and 48% in Australia. An increase in the population using CAM has also been observed in developing countries (Duarte, 2003).
In Latin American societies, the principal motivations for which the population chooses this type of therapy are related to limited access to allopathic medicine due to its high economic cost, distrust of the adverse effects produced by pharmacological treatment, which is the primary medical recommendation, and, above all, the limited chances of curing certain pathologies.
Another reason that explains the increase in the use of ancient practices for the treatment of disease is the globalisation of information, with greater accessibility and cultural exchange resulting from the increase in travel around the world.
The objective of Complementary Medicine is not to replace traditional medicine, but rather to complement and enrich traditional practices for the benefit of the user. Hence the concept of "Complementary" therapies, which more precisely defines its objective (González, 2005).
3.6 COMPLEMENTARY MEDICINE IN CHILE
In Chile, the profile of the alternative medicine user mainly consists of people with high incomes and a high educational and sociocultural level, as well as those suffering from pathologies that are difficult to resolve through traditional medicine, such as chronic pain, mental disorders, oncological conditions, and HIV (CEOC, 2010).
As a result, an increasing number of therapies and practitioners have emerged who apply them without having a medical background and, in most cases, without a real understanding of what they are using or of their adverse effects. Despite this, the Ministry of Health, the Medical Association, and the universities have not adopted a proactive approach in this regard, and there are only isolated examples:
The Ministry of Health has a list of recognised alternative medicines, although it does not include all those currently practised.
The University of La Frontera organises an Alternative Medicine Congress every year and has placed particular emphasis on the integration of allopathic medicine with Mapuche medicine.
In certain hospitals in Santiago, Reiki is being used as an alternative therapy for healthcare personnel, primarily focused on relaxation and musculoskeletal conditions.
With regard to the use of medicinal herbs, homeopathic medicines, and the so-called "natural medicines," a range of "pharmacies" that distribute these products has gradually been established (Godoy, 2003).
The Ministry of Health has implemented a series of measures aimed at the recognition and regulation of these non-conventional practices, with the purpose of considering the incorporation of some of them into the Chilean healthcare system.
In 2005, Decree No. 42 was enacted, regulating the practice of alternative medical therapies by allied health professionals and establishing the conditions under which the centres where these therapies are practised must operate.
Following this regulation, Acupuncture (Decree No. 123/2008) and Homeopathy (Decree No. 19/2010) have been evaluated and officially recognised, while the decree regulating the practice of Naturopathy is currently under review for official recognition (MINSAL, 2012).
3.7 FUNDAMENTALS OF BIOMAGNETISM
When disease occurs, an ionic or pH imbalance is created, which results in an element that is out of harmony with health or homeostasis. External pathogens (bacteria, fungi, viruses) begin to proliferate, adversely affecting the organism and causing disease. If the ionic alteration is corrected, the disease is cured, since the point of equilibrium is restored.
The Biomagnetism system is responsible for detecting altered energy points in the individual. This detection is carried out using passive magnets that are neither electrified nor connected to electronic devices. They are applied to different areas of the body, as a type of biomagnetic scanning or screening. Once the altered areas have been detected, corresponding to organs or tissues that are undergoing some form of distortion, these are corrected by displacing the excess negative charges with the negative pole of the magnet. These charges are then neutralised by the excess positive charges displaced by the positive pole of the magnet, until the point of healthy equilibrium for the organism is reached (Goiz, Mendoza & Mendoza C., 2005).
Miranda (2006) states that treatment with biomagnetic pairs lasts approximately twelve to fifteen minutes. During this period, a bipolar magnetic field is created that first destroys bacteria, viruses, fungi, or parasites, then stabilises glandular function and regulates blood and lymphatic circulation. This treatment cannot and should not be applied to people who use pacemakers or to pregnant women.
This alternative therapy system is fundamentally based on the premise that the production of free hydrogen ions results from the combination of carbon dioxide and water, which, through the action of carbonic anhydrase, produces carbonic acid and hydrogen ions. Likewise, carbonic acid dissociates into carbonate with the production of hydrogen ions. Therefore, if the action of carbonic anhydrase is reduced or eliminated, the production of hydrogen ions can be inhibited or reduced, stabilising the pH through the depolarisation of the biomagnetic pairs (Goiz, 2004).
The biomagnetic pair is defined as a set of charges that identifies a specific pathology and is composed of one positive charge and one negative charge, formed as a result of a fundamental alteration in the pH of specific organs (Goiz, Mendoza & Mendoza C., 2005).
Magnets of the same polarity are placed on these points, producing an interruption in the energetic feedback between viruses and bacteria while simultaneously correcting the pH imbalance. In the case of viruses, their pathogenic DNA charge is destroyed, while in bacteria, the change in pH hinders their reproduction and weakens them against the immune system. Biomagnetism can also correct dysfunctions and metabolic alterations in the organism that originate from these acid-base imbalances (Goiz, 2004).
Biomagnetism is compatible with and complementary to different forms of therapy, such as Homeopathy, Naturopathy, Bach Flower Remedies, Reiki, among others. Therefore, it may be used simultaneously with traditional allopathic treatments.
This new medical alternative is based on the magnetic properties of the organism and consists of three elements:
The Normal Energy Level (NEL), where the pH is practically neutral and all the normal vital functions of the human organism are carried out. No organic pathology exists.
The positive pole, which is generated by an excess of hydrogen ions, where the pH is acidic and gives rise to the presence of viruses.
The negative pole, which is generated by a deficiency of hydrogen ions and by the presence of complex free radicals with negative polarity, where the pH is alkaline, giving rise to the development of bacteria (CBMEC, 2006).
Legally, Biomagnetism is represented in the country by the College of Biomagnetism and Bioenergetics of Chile, a non-profit professional association whose purpose is the professional development, legal protection, and advancement of those pioneering this therapy in the country. It currently consists of 200 biomagnetic therapists registered with the College and accredited directly by Dr Isaac Goiz Durán. They also hold certification awarded by the Autonomous University of Chapingo, Mexico (CBBCh, 2004).
3.8 BIOMAGNETISM AND CHRONIC PAIN
The analgesic effect of the magnetic fields manifested through Biomagnetism therapy is a consequence of their anti-inflammatory effects. It is important to note that the plasma membrane possesses an electrical field potential, which is in constant movement and equilibrium. Biomagnetism regulates this potential by raising the pain threshold in the sensory nerve fibres, resulting in both a direct and indirect intervention in the mechanism of pathogenic pain (Martín & García, 2005).

4. OBJECTIVES
4.1 GENERAL OBJECTIVE
To determine the perception of Biomagnetism users regarding Biomagnetism as an alternative/complementary medicine for the treatment of chronic pain.
4.2 SPECIFIC OBJECTIVES
To identify the motivations that led Biomagnetism users to choose an alternative/complementary therapy as a treatment for pain relief.
To describe the results perceived by Biomagnetism users after using this therapy for pain relief.
To describe the experience of Biomagnetism users with alternative/complementary medicine versus allopathic medicine.

5. METHODOLOGY
Qualitative research is defined by Lincoln and Denzin (1994) (cited in Rodríguez, 1999) as "an interdisciplinary, transdisciplinary, and on many occasions counter-disciplinary field. It crosses the social and physical sciences. It is multiparadigmatic in its approach. Those who practise it are committed to the naturalistic perspective and to the interpretative understanding of human experience."
It is also appropriate to cite Taylor and Bogdan (1986) (cited in Rodríguez, 1990), who consider qualitative research to be "that which produces descriptive data: people's own spoken or written words, and observable behaviour."
The purpose of qualitative research is to understand and interpret reality as conceived by the subjects participating in the contexts under study. However, this understanding is not of interest solely to the researcher. The results of the research must be shared and communicated, as appropriate, to the sponsors of the study, to the participants themselves, or, insofar as they contribute to the advancement of scientific knowledge regarding a particular reality, to the wider research community.
The approach is based on methodologies for data collection that are neither standardised nor fully predetermined. No numerical measurement is carried out; therefore, the analysis is not statistical. Data collection consists of obtaining the participants' perspectives and points of view (their emotions, priorities, experiences, meanings, and other subjective aspects). The interactions between individuals, groups, and communities are also of interest. The researcher asks open-ended questions, gathers data expressed through written, verbal, non-verbal, and visual language, describes and analyses them, organises them into related themes, and recognises personal tendencies (Todd, 2005).
Unlike qualitative research, quantitative research provides the possibility of systematising results more broadly. It allows control over phenomena, as well as a perspective based on counting and measurement. Likewise, it offers a greater possibility of replication and an approach focused on specific aspects of such phenomena, while also facilitating comparison between similar studies.
Qualitative research is exploratory, inductive, and descriptive. Through different instruments, it allows the researcher to obtain the characteristics of a given phenomenon and real data concerning the problem under study, thereby enabling the development of the research process. It has a dynamic reality; that is, it is a process that begins at a particular moment and develops over time. Qualitative researchers participate in the research through their interaction with the subjects they study; the researcher is the measuring instrument.
The design of this study was phenomenological in nature, focusing on the participants' subjective individual experience. It seeks to recognise people's perceptions and the meaning of a phenomenon or experience.
According to Creswell, Álvarez-Gayou, and Mertens, phenomenology is based on the following premises: the study seeks to describe and understand phenomena from the point of view of each participant and from the collectively constructed perspective. It is based on discourse analysis and specific themes, as well as on the search for their possible meanings. The researcher contextualises experiences in terms of their temporality (the time at which they occurred), space (the place where they occurred), corporeality (the people who experienced them), and the relational context (the relationships generated during the experience) (Hernández Sampieri, 2010).
To determine the sample, access was obtained through a key informant who helped identify the research participants. Interviews were conducted with eight individuals ranging in age from 18 to 70 years, regardless of sex, using the snowball strategy. The criterion for ending the interviews was theoretical saturation, that is, the point at which the interviews no longer contributed new information. The study focused on Biomagnetism users who employed this therapy for pain relief and who attended private healthcare centres in the city of Valdivia.
For data collection, semi-structured interviews were used, characterised by the flexibility and adaptability of the questions to explore the participant's inner perspective: their thoughts, perceptions, and experiences. At the beginning of the interview, a guiding question was posed, after which additional questions were asked so that the participant could provide information relevant to the research. The interviewer was required to possess certain skills, including personality, attitude, willingness, and the ability to establish a relationship of trust with the interviewee.
The data collection technique consisted of recorded interviews and audio recordings, which were subsequently transcribed into Microsoft Word format. This information was processed and coded in order to obtain results that addressed the research questions. Information was analysed using software called ATLAS.ti, which offers three possibilities for analysis: in vivo or open coding, list coding, and coding through an emergent code matrix. For the interpretation of the information, we focused on coding through an emergent code matrix. Through data analysis, codes and patterns emerged that were repeated and associated with one another, as described by Valles (2007): "once coding has been completed for each transcription, all the fragments belonging to the same section are brought together," grouping them into dimensions. These associations were made according to common themes or according to the importance of a particular quotation within the data.
One of the ethical principles considered in conducting the study was respect. The conviction that all individuals should be treated as autonomous agents formed the ethical basis upon which the study was conducted. At the beginning of the study, all the necessary information was provided to the participants, taking into account their prior knowledge and personal characteristics.
At all times, emphasis was placed on the voluntary nature of participation, allowing participants to withdraw from the study at any stage without having to justify their decision. This was recorded in writing in the informed consent form, which each participant signed before taking part in the study.
Finally, the ethical principle of justice was upheld throughout the research, ensuring that the vulnerability of the participants was not compromised.
All information relating to the identity of the participants provided to the researchers was treated as confidential. Participants were also informed that they would receive no benefit other than the satisfaction of contributing to the study, and that the handling of the data collected and the results would not result in any harm.
6. PROJECTIONS
The principal purpose of this study is to make known a relatively new form of alternative or complementary medicine, for which there is limited research, but which, undoubtedly, according to both the practitioner who applies it and the user who receives it, provides multiple benefits and effectiveness in the treatment of different human diseases, including cases in which the biomedical method itself does not find solutions. Therefore, it may be considered as a treatment or as an adjunct in many health problems, bearing in mind that it not only brings benefits in the biological sphere, but also in the psychological sphere, for the benefit of the biopsychosocial individual, pursuing the objective of comprehensive and high-quality nursing care.
For this reason, it constitutes a valuable tool within the nursing discipline, while also providing nursing professionals and other healthcare professionals with a different option for delivering care to users in an autonomous and independent manner, with the confidence that patients will receive the care they require.
7. PRESENTATION, ANALYSIS, AND DISCUSSION OF RESULTS
The analysis of the data and the presentation of the results will be carried out in three (3) stages:
(1) the codes were grouped into dimensions, each referring to units of text fragments from the interviews that were interpreted in a similar manner;
(2) these codes were intentionally organised to address each of the specific objectives, whereby each dimension establishes relationships of similarity among the responses;
and finally,
(3) the codes were brought together on the basis of causal relationships, represented in conceptual maps, in order to understand the complexity of the problem and to address the general objective, which proposes the characterisation of Biomagnetism users' perceptions.
7.1 DIMENSIONS AND CODES
Consequently, the dimensions that emerged from establishing the associative, causal, and characterising relationships among the emergent codes are presented below:
Previous experiences: this dimension groups together codes related to the patient's experiences prior to receiving treatment, placing emphasis on the situations produced by the pain experienced by the patient.
Reasons for seeking therapy: this group of codes includes those that refer to the reasons why the patient attends the therapy. These may result from either intrinsic or extrinsic motivation.
Knowledge of Biomagnetism: this dimension brings together the codes that describe the way in which the patient became aware of alternative medicine, particularly Biomagnetism.
Results experienced: this dimension groups together the codes that refer to the positive results experienced by the patient during and/or after the therapy.
Experience with Biomagnetism: this dimension describes the patient's experience with Biomagnetism therapy, ranging between two extremes, from a negative experience to a positive experience that leads the patient to recommend the therapy.
Views on alternative medicine: this dimension brings together the codes that express the participants' views after having used alternative medicine.
Lack of knowledge of alternative medicine: this group of codes includes those indicating that the patient had no prior knowledge of this type of alternative medicine.
Secondly, the matrix of emergent codes resulting from the analysis of the seven (7) interviews within a Hermeneutic Unit is presented. Each code belongs to a dimension and includes a descriptor, the latter being the definition of the code based on the description of the information collected.

Table 1. Matrix of Emergent Codes
Dimension
Code
Descriptor
Previous Experiences
Poor lifestyle
The patient has a lifestyle in which they do not establish effective personal relationships, reduce time spent interacting with others, and limit themselves when carrying out everyday activities, such as going shopping.
Severe pain
Severe pain affecting the patient.
Limitation due to pain
The patient limits his or her activities as a result of the pain they are experiencing.
Unable to work
This code represents that the patient is unable to work because of the pain experienced.
Tired of working
The patient was tired of working.
Denial of severe pain
Despite experiencing pain, the patient does not make it known.
Reinforcing pain
The patient intensifies his or her pain as a consequence of personal thoughts.
Previous family tragedies
Previous tragedies that affected the patient are identified.
Reasons for Seeking Therapy
Personal experience
Based on his or her experience with Biomagnetism, the patient continues with the therapy or would undergo it again if needed.
Willingness to recover
The patient expresses interest and willingness to recover.
Seeking a solution
This code refers to the moment when the patient seeks a solution to overcome the pathology affecting them.
Encouragement from a family member
A member of the patient's family encourages or insists that they participate in the therapy.
Overcoming pain
The patient seeks to overcome the pain affecting them.
No results with traditional medicine; tries alternative medicine
As there are no results with traditional medicine, alternative medicine is tried.
Feeling better
The patient attends the therapy in order to feel better.
Feeling of desperation
The patient is desperate because of the pain affecting them.
Knowledge of Biomagnetism
Third party introduces it to the family
A person outside the family introduces the family to the alternative medicine, Biomagnetism.
Information from a third party
A person outside the family or circle of friends introduces the patient to the alternative medicine, Biomagnetism.
Nurse introduces Biomagnetism
A nurse introduces the patient to the alternative medicine, Biomagnetism.
Father's experience
The patient decides to attend based on the father's experience.
Concern from other people
Friends, relatives, or acquaintances express concern about the patient's health.
Results Experienced
Change from negative to positive
The patient experiences a change in the way everyday situations are viewed; previously everything was perceived negatively, evolving towards a positive outlook.
Excellent results
This code represents the excellent results obtained by the patients during the therapy.
Reduction in pain
The patient reports a reduction in pain as a result of the therapy.
Improved mood
The patient reports an improvement in mood as a result of the therapy.
Immediate positive results
This code indicates that the patient experienced positive results immediately after undergoing the therapy.
Holistic change
The therapy produces both psychological and physical changes.
Improved personal relationships
A noticeable improvement is observed in the patient's personal relationships.
Gradual reduction in pain
Pain decreases gradually as the therapy progresses.
Enjoying life
The patient enjoys daily activities and engages in pleasurable activities.
Feeling useful
The patient feels useful because they are able to carry out their normal activities.
Willingness to go out
The patient wishes to go out with family members or friends.
Looking for the positive
Despite life's difficulties, the patient chooses to look for the positive in each situation encountered on a daily basis.
Experience with Biomagnetism
Therapist 100% dedicated
The therapist is always present and fully dedicated to each patient throughout the session.
Excellent therapist
Describes good therapeutic practice.
Pain during therapy
The patient reports experiencing pain during the session.
Negative experience
Negative experience during a Biomagnetism session.
Poor therapist
Therapist who shows little attentiveness towards the patient.
Sensation of expelling something
The patient reports the sensation of expelling something from the body during the session.
Combining alternative medicine with traditional medicine
Alternative medicine is combined with traditional medicine.
Unable to relax
The patient feels uncomfortable and is therefore unable to relax during the therapy.
Views on the Therapy
Recommending alternative medicine
The patient recommends alternative medicine, in this case Biomagnetism.
Change in perception of alternative medicine
The patient changes his or her perception of alternative medicine as a result of participating in it.
Alternative medicine is cheaper
Alternative medicine is less expensive than traditional medicine.
Alternative medicine is better
The patient considers alternative medicine to be better.
Lack of Knowledge of Alternative Medicine
Lack of knowledge of alternative medicine
The patient has no knowledge of alternative medicine.

The following table presents the frequency of occurrence of the codes that emerged from the interviews. It corresponds to the number of times each of the previously presented codes was repeated within the data collected from the seven (7) interviews.

Table 2. Frequency of Occurrence
Frequency
Category
16
Change from negative to positive
12
Excellent results
11
Reduction in pain
10
Improved mood
10
Seeking a solution
10
Severe pain
10
Poor lifestyle
9
Recommending alternative medicine
9
Feeling better
8
Personal experience
8
Alternative medicine is better
7
Overcoming pain
7
Concern from other people
7
Immediate positive results
6
Denial of severe pain
6
Limitation due to pain
6
Willingness to recover
6
Holistic change
6
Change in perception of alternative medicine
6
Combining alternative medicine with traditional medicine
6
Excellent therapist
5
Encouragement from a family member
5
Third party introduces it to the family
5
Lack of knowledge of alternative medicine
4
Information from a third party
4
No results with traditional medicine; tries alternative medicine
4
Enjoying life
4
Unable to work
4
Therapist 100% dedicated
4
Improved personal relationships
3
Alternative medicine is cheaper
3
Reinforcing pain
2
Willingness to go out
2
Gradual reduction in pain
2
Unable to relax
2
Sensation of expelling something
2
Feeling useful
2
Previous family tragedies
2
Father's experience
2
Negative experience
1
Looking for the positive
1
Pain during therapy
1
Nurse introduces Biomagnetism
1
Poor therapist
1
Tired of working
1
Feeling of desperation

7.2 OBJECTIVES AND CODES
To address the specific objectives, each of the codes was grouped into dimensions that allow for a clear organisation and classification of the information obtained from the data collection instrument. Accordingly, three orientations were identified in the responses: motivations, experiences, and results.

7.2.1 MOTIVATIONS
The objective is to identify the motivations that lead a patient to seek alternative medicine, specifically Biomagnetism, and to continue treatment with it. The dimension that addresses this objective is "Reasons for Seeking Therapy," which comprises the following codes and their frequency (in parentheses): seeking a solution (10), personal experience (8), overcoming pain (7), willingness to recover (6), encouragement from a family member (5), no results with traditional medicine, tries alternative medicine (4), feeling better (1), and feeling of desperation (1).
Undoubtedly, the code with the highest frequency is seeking a solution, as expressed by Participant 2: "I went as an alternative, looking for some solution to the pain" (E2:1), or as reaffirmed by Participant 7: "Looking for alternatives for my pain and everything" (E7:1). The pain referred to here is linked to the code overcoming pain as a significant motivation for the patient, as a result of the different effects it produces, as expressed by Participant 2:
"Well, I couldn't rest because lying in bed made the pain worse, so I didn't lie down. I spent several nights, I think two or three nights, without sleeping at all... So I had to look for another alternative, although I was still taking my medication." (E2:10)
The experience the patient has once entering Biomagnetism therapy is fundamental to the continuation of treatment, as reflected in the words of Participant 7:
"I felt relief, that's why I went back." (E7:8)
and
"Although if I stop going, the pain comes back, so that's why I try not to miss many sessions." (E7:20)
Undoubtedly, the results obtained with a particular therapy contribute to the patient's adherence to treatment. Failure to achieve the expected results may motivate the search for another type of treatment, such as Biomagnetism. Many of the interviewees stated:
"I took the dose he prescribed and... the pain continued, and... we were considering the option... through my husband they had offered me the possibility of trying an alternative therapy for the pain..." (E2:44)
together with:
"I went to the doctor, but nothing worked, and after about a year I met this lady who told me it had worked for her, so I decided to go." (E5:7)
Both excerpts are grouped under the code No results with traditional medicine; tries alternative medicine.
Human beings are social beings who live in communities, and one of these communities is the family, the foundation of every society. Therefore, the physical and psychological health of one member affects the group as a whole. Family members seek the well-being of the group and therefore encourage the patient to attend therapy after observing the limitations in daily activities or the difficulties in carrying them out because of pain, as described by Participant 3:
"But when the pain started, I didn't stop doing gymnastics, I didn't stop going to my workshop, I didn't stop going out or doing my things, I didn't stop doing things around the house. I kept doing them, but of course there were days when the discomfort was much worse. Then my son said to me: Mum, try this. And honestly, yes, of course it has helped me a lot, my mood as well. Yes, I recommend it..." (E3:12)
Based on the above, we can conclude that the principal motivations for attending the therapy are seeking a solution to overcome pain because traditional medicine has not provided the expected answers, with family support being fundamental both for initiating and continuing the treatment.

7.2.2 EXPERIENCES
The objective is to describe the experiences of Biomagnetism users with Biomagnetism as an alternative/complementary medicine. The dimension that addresses this objective is "Experience with Biomagnetism," which includes the following codes and their frequency (in parentheses): excellent therapist (6), therapist 100% dedicated (4), combining alternative medicine with traditional medicine (6), pain during therapy (2), negative experience (2), sensation of expelling something (2), unable to relax (2), and poor therapist (1).
The experiences are situated at two extremes. On one hand, the patient highlights the positive characteristics of the therapist, who understands what contributes to a positive experience through comprehensive care, as expressed by Participant 3:
"This time it worked because Roxana stayed with me the whole time, with music, with everything... she has everything set up. Afterwards she also gave me Reiki, she gave me two Reiki sessions." (E3:41)
Added to this is the dedication shown by the therapist:
"No, Roxana is always one hundred per cent dedicated to what she does, one hundred per cent. She never left me alone for a single minute, always asking me how I was, changing the magnets." (E3:45)
Clearly, the therapist's professional qualities contribute to making the experience a positive one.
At the opposite extreme, the therapy was perceived as a negative experience because of pain felt during the session and the perception that the therapist was not very effective. This is described by Participant 3:
"No, when I went to the clinic I already knew what I was going for, but because it wasn't like it was with the nurse, she had to keep going in and out, in and out. I don't know... for me, at that time, several years ago, it was a waste of time." (E3:25)
It is important to emphasise that this negative experience was reported by a participant during her first visit. Despite this, she sought another practitioner within the same therapy. She subsequently expressed complete satisfaction and surprise, as shown in the following excerpt:
"No, Roxana is always one hundred per cent dedicated to what she does, one hundred per cent. She never left me alone for a single minute, always asking me how I was, changing the magnets." (E3:45)
Despite everything, among the experiences developed by patients in their search to overcome pain, pain itself emerged as something considered normal during the therapy, according to Participant 2:
"She told me it was normal, that if I came to the therapy, I had to feel pain with the magnets because, basically, the magnets were putting... I don't know... my energies back into place." (E2:45)
Undoubtedly, alternative therapies are an important source of hope for those people for whom traditional medicine has not produced the desired results. In this case, Participant 4 reported combining both types of medicine to avoid pain:
"No, I kept taking them... a smaller amount, yes, but I kept taking them... for now I'm only taking 150 mg of Lertus... and sometimes at night when I go to bed I apply the Lertus cream as well. It gives me a kind of warmth... really to stop it from hurting..." (E4:14)
and, in a certain way, as a means of increasing the benefits provided by alternative medicine, in this case Biomagnetism.
Therefore, the experiences can be summarised as positive experiences resulting from the dedication shown by the therapist, which creates a favourable impression of the practitioner. Conversely, negative experiences were considerably less frequent, allowing us to conclude that Biomagnetism therapy for the relief of chronic pain is perceived as a patient-friendly therapy.

7.2.3 RESULTS
The objective is to describe the results perceived by Biomagnetism users after using this therapy for pain relief. The dimension that addresses this objective is "Results Experienced," which is composed of the following codes and their frequency (in parentheses): change from negative to positive (16), excellent results (12), reduction in pain (11), improved mood (10), immediate positive results (7), holistic change (6), improved personal relationships (4), enjoying life (4), gradual reduction in pain (2), feeling useful (2), willingness to go out (2), and looking for the positive (1).
All of the results reported by the patients were positive in nature, ranging from a reduction in physical pain to a change in the way they viewed life. The code with the highest frequency was change from negative to positive. The excerpts illustrating this situation refer to a broad change in the participants' lives, as expressed by Participant 2:
"I've taken a shower in the afternoon and put on my pyjamas, but in good spirits, not the way I was before. Before the therapy I saw everything as ugly, girls, everything was ugly. I didn't feel like doing anything. So it's like... I don't know how those metals work inside you, or maybe it's the therapist." (E2:16)
The relationships established between the codes within this dimension are striking because one of the outcomes is reflected in the reduction in pain, which is undoubtedly related to improved mood, excellent results, and immediate positive results, as expressed by Participant 2:
"Yes, everyone, the whole family knew, and they came to see me. I used to tell them, 'What's the point of coming to see me if... we have to find a solution?' Then, when they saw the change, they were absolutely amazed." (E2:5)
This is reaffirmed by Participant 3:
"Yes, my mood, because now I don't wake up angry or grumpy in the mornings... now I wake up much happier. So I feel much better in every way." (E3:13)
Pain was the principal stimulus that motivated the patients to undergo Biomagnetism therapy, and the effectiveness of this therapy followed two patterns: one immediate, as expressed in the following excerpt:
"The very first time I had it done... I recovered immediately." (E3:1)
and the other gradual, as expressed by Participant 5:
"After the first session I felt better, and by the third I was great." (E5:9)
Participant 1 states:
"Yes, my mood, because now I don't wake up angry or grumpy in the mornings... now I wake up much happier. So I feel much better in every way." (E1:13)
From this statement emerge the ideas of an improved mood and improved personal relationships. From this quotation, it is important to emphasise the significance of pain reduction in the overall range of activities carried out in daily life. Consequently, the results encompass the individual as a whole, from the way they think to the way they relate to others.
This idea is clearly expressed by Participant 7 when asked whether Biomagnetism had helped improve quality of life:
"Yes, because, for example, I had a session last week, then at the weekend I went to the coast and I didn't have any pain or anything. Yes, I've felt much better." (E7:10)
In relation to this, it is possible to establish a chain of effects beginning with pain reduction and leading to considerable improvements in quality of life.
On the other hand, when the results are observed as a consequence of applying a particular stimulus, another dimension emerges that is directly related to the results: Views on the Therapy. This group of codes consists of: recommending alternative medicine (9), alternative medicine is better (8), change in perception of alternative medicine (6), and alternative medicine is cheaper (3).
Participant 3 expresses two of the codes belonging to this dimension:
"Well, the only ones I've tried are this one and Reiki, but as I said, Roxana is outstanding in that respect, really, really good. I can't say anything except words of gratitude. It has changed my perception, and I recommend it one hundred per cent." (E3:42)
Here, based on a positive experience, the participant changes his or her perception of alternative medicine and goes on to recommend this type of therapy.
It is essential to understand that the change in perception is linked to the results:
"Biomagnetism, because I don't take the tablets anymore. I realised that even after following my treatment consistently for some time, everything still hurt... then when I started coming here, I began to feel better. So I feel that Biomagnetism works better." (E1:4)
Consequently, this leads to the perception that alternative medicine is much more effective than traditional medicine.
To address this third objective, which refers to the results, the codes from two dimensions were presented: Results Experienced and Views on the Therapy. However, it should be noted that the codes belonging to Results Experienced were considered first-order codes and that, as a consequence of these, the codes within the Views on the Therapy dimension emerged, which were also considered outcomes of the therapy.
Participant 5 clearly expresses this process:
"Let's see... about a year... yes, about a year, because for a few months I just endured it, rubbing ointments on to see if it would go away... then I went to the doctor, but nothing worked, and after about a year I met this lady who told me it had worked for her, so I decided to go... after the first session I felt better, and by the third I was great. Without a doubt, Biomagnetism helped me much more." (E5:1)

8. CONCLUSION
Nursing Care Management is understood as the professional practice of the nurse, founded upon the discipline and science of caring. It is defined as the application of professional judgement in the planning, organisation, motivation, and control of the provision of timely, safe, and comprehensive care, ensuring continuity of care and supported by the institution's policies and strategic guidelines (MINSAL, 2007).
In relation to alternative therapies, care management is also present, since its principal objective is to generate positive results in order to provide quality, less invasive healthcare for the benefit of patient care.
Nursing research provides a setting for the construction of knowledge, as well as a tool that enables the professional to advance the development of the study of medicine, professional education, and, above all, the improvement of users' quality of life.
Like other alternative therapies, Biomagnetism has demonstrated its benefits worldwide in relation to the resolution of health problems, specifically chronic pain. In this study, positive results were demonstrated through the real experiences described above. The results have demonstrated effectiveness in reducing or eradicating pain, improving users' quality of life, and, above all, changing patients' perceptions following their first experience with this therapy.
Another important point to mention regarding this complementary therapy is the change in the perspective of the nursing discipline, which broadens the professional field of practice by enabling nurses to view the patient in a holistic manner. Although it is a relatively new therapy, it has demonstrated the validity of its results over recent decades through research that provides a scientific basis.
In this study, the findings are consistent with those reported in the majority of research associated with this therapy, owing to the benefits that were consistently identified throughout each of the interviews conducted. For this reason, the findings of this thesis are intended to promote knowledge of Biomagnetism among the general population, and specifically among people who suffer from chronic pain, have not obtained results with conventional medicine, and are unaware of this therapy as an adjunct to conventional treatment.
9. APPENDICES
9.1 INFORMED CONSENT
I have been invited to participate in a research study conducted by undergraduate nursing students from the Austral University of Chile (UACh). The study aims to collect the perceptions of Biomagnetism users regarding Biomagnetism as a therapy for the relief of chronic pain in the city of Valdivia during the period from May to July 2013.
I agree to:
Participate in an interview that will be audio-recorded and conducted during the month of June of the present year, following prior contact to establish the date, location, time, duration, and interviewer.
I understand that:
My participation guarantees the privacy and confidentiality of the information I provide. Access to this information will be restricted to the researchers, and my identity will not be disclosed. Once the information has been used, it will be stored securely for five years and subsequently destroyed.
The results of the study will be publicly available.
I have the right to be informed of the results of the study and to access my data whenever I consider it necessary.
My participation in this study is entirely voluntary, and I may withdraw at any time without giving reasons and without fear of any repercussions.
I will not receive any financial or other form of compensation for my participation.
If I have any questions, I may contact the principal researchers at the following telephone numbers:
Yocelyn Collinao: 79316870
Carolina Cárdenas: 78821716
María José Mera: 84235434
or by e-mail at:
tesisbiomagnetismo2013@gmail.com
This informed consent has been reviewed and approved by the Ethics Committee of the Valdivia Health Service.
I ACCEPT
I DO NOT ACCEPT

PRINCIPAL RESEARCHERS
PARTICIPATING USER
Carolina Cárdenas
Yocelyn Collinao
María José Mera

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